ANTI-HYPERGLYCEMIC EFFECT OF TERMINALIA CATAPPA FRUIT EXTRACT IN STREPTOZOTOCIN-INDUCED DIABETIC RATS

Objective: To explore the anti-hyperglycemic effect of fruit extract of Terminalia catappa (Indian almond), a potential medicine from plant origin in a diabetic rat model.Methods: Streptozotocin-induced chronic diabetic rat model was utilized in the study. Three doses of test drug, hydro-alcoholic fruit extract of Terminalia catappa in 20 mg/kg, 30 mg/kg and 40 mg/kg and a standard anti-diabetic drug, glibenclamide (10 mg/kg) was used. The study had a total of nine groups with eight animals in each group. Drugs were given orally every day for 12 w. Blood glucose, body weight and urine volume were measured weekly, glycosylated hemoglobin (HbA1c) was estimated at 12th week in all groups. Data for all parameters were analyzed using one-way ANOVA repeated measures followed by Mann-Whitney test.Results: Hydro-alcoholic fruit extract of T. catappa significantly decreased blood glucose, urine volume and increased body weight in a dose-dependent manner in diabetic rats. At 12th week, blood glucose level in control, diabetic control, glibenclamide, T. catappa (40 mg/kg) group was 96.25±2.05 mg/dl, 599.75±0.25 mg/dl, 248.25±11.45 mg/dl, 115.00±3.78 mg/dl respectively. Effect of T. catappa in 30 mg/kg and 40 mg/kg dose was significantly more than glibenclamide. At 12th week, HbA1c level in control, diabetic control, glibenclamide, T. catappa (40 mg/kg) was 2.94±0.33 mmol/l, 4.94±0.49 mmol/l, 3.61±0.28 mmol/l, 3.21±0.27 mmol/l. Treatment with T. catappa 30 mg/kg, 40 mg/kg and glibenclamide brought back the level of HbA1c to normal levels. The addition of glibenclamide to T. catappa (40 mg/kg) did not produce any additional effect on blood glucose and HbA1c levels compared to the effect of T. catappa (40 mg/kg) in diabetic rats.Conclusion: Terminalia catappa fruit extract exhibited a significant anti-hyperglycemic effect in diabetic rats and has a great potential to be used in diabetes

Prescriber and Dispenser Perceptions About Antibiotic Use in Acute Uncomplicated Childhood Diarrhea and Upper Respiratory Tract Infection in New Delhi: Qualitative Study

DiarrhoeaOBJECTIVE: The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior. MATERIALS AND METHODS: Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8–12 participants and lasted 2 h. Furthermore, 22 individual face‑to‑face semi‑structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done. RESULTS: All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow‑up and in addition for GDs, workload, no diagnostic facility, and pressure to use near‑expiry medicines. Knowledge was gained through self‑experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations. CONCLUSIONS: A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use

India\u27s ban on antimicrobial fixed-dose combinations: Winning the battle, losing the war?

BACKGROUND AND OBJECTIVES: India, the country with the largest market availability of antimicrobial fixed-dose combinations (FDCs), banned certain antimicrobial FDCs in September 2018. Our objective was to examine the impact of Government ban on the sales of antimicrobial FDCs. METHODS: The sales patterns of 14 of the 26 banned antimicrobial FDCs were analyzed using monthly private sector drug sales data from IQVIA (a comprehensive and nationally representative drug sales database) between January 2018 and December 2019. We carried out descriptive analyses to evaluate the trend in sales over time for banned and non-banned antimicrobial FDCs using cumulative sales volumes. RESULTS: Overall, the cumulative sales volume of banned antimicrobial FDCs declined by 75% between January and September 2018 and the same months of 2019, although some banned FDCs continued to be available in significant volumes. The effectiveness of the ban was offset by several pathways. First, the sales of combinations containing moieties belonging to the same drug-classes as the antimicrobials in the banned FDCs increased after the ban. Second, while certain formulations of particular combinations were banned, the sales of other non-banned formulation of these combinations increased. Third, in some cases, products containing new non-antimicrobial components added to the banned combinations remained available. INTERPRETATION AND CONCLUSIONS: While sales of the banned antimicrobial FDCs decreased in 2019, we identified several mechanisms that counterbalanced the ban, including implementation failure, rising sales of congeners, and products with additional non-antimicrobial components

Antibiotic Use in South East Asia and Policies to Promote Appropriate Use: Reports from Country Situational Analyses

Inappropriate use of antibiotics is rampant in South East Asia1-6 and is a major contributor to antimicrobial resistance.7-9 However, data on antibiotic use are scant, few effective interventions to improve appropriate antibiotic use have been implemented,10 11 and implementation of policies for appropriate use of antibiotics is also poor.12 13 An analysis of secondary data on antibiotic use from 56 low and middle income countries found that countries reporting implementation of more policies also had more appropriate antibiotic use.14 15 Effective policies included having a government health department to promote rational use of medicines, a national strategy to contain antimicrobial resistance, a national drug information centre, drug and therapeutic committees in more than half of all general hospitals and provinces, and undergraduate education on standard treatment guidelines.15 An updated essential medicines list and national formularies were also associated with lower antibiotic use

Adopting an intersectoral One Health approach in India: Time for One Health Committees

Following the several episodes of zoonotic disease outbreaks and the more recent COVID-19 pandemic, the Indian policy initiatives are committed to institutionalize One Health (OH) approaches and promote intersectoral, transdisciplinary collaboration and cooperation. The OH principle needs to be visualized beyond the scope of zoonoses. While conservation, ecological and veterinary professions are getting increasingly engaged with OH, most of the medical/clinical and social sciences professions are only peripherally aware of its nuances. The OH initiatives, by their essentially multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. The logical operational step will be the constitution of One Health Committees (OHC) at the State and district levels. Here, we outline the key foundational principles of OHC and hope that the framework for implementation shall be deliberated through wider consultations and piloted and adopted in a phased mannerAuthors acknowledge the financial support received from UK Research and Innovation (UKRI) Global Challenges Research Fund (GCRF) One Health Poultry Hub (grant BB/SO11269/1)

Trends in antibiotic use among outpatients in New Delhi, India

<p>Abstract</p> <p>Background</p> <p>The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. There is much ad-hoc information about the inappropriate consumption of antibiotics, over-the-counter availability, and inadequate dosage but there is very little actual evidence of community practices.</p> <p>Methods</p> <p>This study surveyed antibiotic use in the community (December 2007-November 2008) using the established methodology of patient exit interviews at three types of facilities: 20 private retail pharmacies, 10 public sector facilities, and 20 private clinics to obtain a complete picture of community antibiotic use over a year. The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose (DDD) measurement units were assigned to the data. Antibiotic use was measured as DDD/1000 patients visiting the facility and also as percent of patients receiving an antibiotic.</p> <p>Results</p> <p>During the data collection period, 17995, 9205, and 5922 patients visiting private retail pharmacies, public facilities and private clinics, respectively, were included in our study. 39% of the patients attending private retail pharmacies and public facilities and 43% of patients visiting private clinics were prescribed at least one antibiotic. Consumption patterns of antibiotics were similar at private retail pharmacies and private clinics where fluoroquinolones, cephalosporins, and extended spectrum penicillins were the three most commonly prescribed groups of antibiotics. At public facilities, there was a more even use of all the major antibiotic groups including penicillins, fluoroquinolones, macrolides, cephalosporins, tetracyclines, and cotrimoxazole. Newer members from each class of antibiotics were prescribed. Not much seasonal variation was seen although slightly higher consumption of some antibiotics in winter and slightly higher consumption of fluoroquinolones during the rainy season were observed.</p> <p>Conclusions</p> <p>A very high consumption of antibiotics was observed in both public and private sector outpatients. There was a high use of broad spectrum and newer antibiotics in the community. Suitable and sustainable interventions should be implemented to promote rational use of antibiotics that will help in decreasing the menace of antibiotic resistance.</p

Promoting Quality Use of Medicines in South-East Asia: Reports from Country Situational Analyses

Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them